By ULY CLINIC

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Incomplete abortion

 

Introduction

 

Some of the products of conception have been retained in the uterine cavity and there is persistent lower abdominal pain, continuing per vaginum bleeding and open cervix.

  

Diagnostic Criteria

 

• Cramping lower abdominal pain 

• Slight to profuse per vaginal (PV) bleeding accompanied with clots/products of conception 

• Clots/ products of conception protruding through the cervical 

• Fundus smaller than dates 

• The cervix is dilated and products of conception may be felt in the cervix on digital examination 

 

Management of incomplete abortion in dispensary & health centre

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• Apply Airway, Breathing, Circulation and Dehydration principles of resuscitation 

• Check hemoglobin level 

• Give IV RL/NS 2lts

• Perform digital evacuation of products of conception 

• Perform MVA in health centre if gestation age is below 12 weeks  

 

Pharmacological Treatment 

• Oxytocin 10 IU IM    

OR  

• Misoprostol 600μg PO start  

 

After evacuation give:   

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• Amoxicillin PO 500mg 8 hourly for 5 days   

AND  

• Metronidazole PO 400mg 8hourly for 5 days  

AND 

• Paracetamol 1g 8 hourly for 5 days 

 

Referral

 

Refer patient to hospital level with an escort of a nurse if bleeding continues  

 

Management in a Hospital

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• Apply ABCD principles of resuscitation 

• Obtain blood for HB, grouping and cross–matching 

• blood transfusion if indicated 

• Give IV RL/NS 2lts   Digital evacuation of products of conception 

• MVA if gestation age is below 12 weeks 

• Evacuate uterus in theatre with sharp curette under general anesthesia if pregnancy is more than 12 weeks  

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Pharmacological Treatment

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• Continue as above 

 

Patient education.

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• Counsell and provide appropriate contraception.

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Updated on, 3.11.2020

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References

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1. STG